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Bell Ringer How do you know someone is dead? In the 1800s doctors had to judge life and death on the basis of detectable heart sounds, pulse, temperature,

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Presentation on theme: "Bell Ringer How do you know someone is dead? In the 1800s doctors had to judge life and death on the basis of detectable heart sounds, pulse, temperature,"— Presentation transcript:

1 Bell Ringer How do you know someone is dead? In the 1800s doctors had to judge life and death on the basis of detectable heart sounds, pulse, temperature, pallor (paleness) of the skin, and rigor mortis (stiffness which occurs after death). Consequently, fear of being buried alive approached a phobia for some people in the 1800s. Franz Hartmann, author of Premature Burial, located 700 cases of people being buried alive or narrowly escaping it. The Society for the Prevention of Premature Burial was founded in 1896, and in 1897 a patent was issued for a device for allowing an awakened corpse to signal people above ground.

2 Death, Dying and Bereavement

3 What is a modern definition of death? In 1968, the International Council of Medical Science established four criteria for diagnosing death: 1. Loss of all response to the environment 2. Complete abolition of reflexes and loss of muscle tone 3. Cessation of spontaneous respiration 4. Abrupt decline in arterial blood pressure More recently (around 1983) a simpler, more uniform definition was adopted by many American states: death is total and irreversible cessation of brain function.

4 What was Becker's thesis in Denial of Death? Death, and our awareness of it, is a primary motivating force for humans. We will do anything to evade it or psychologically negate its reality. Psychiatrist Ernest Becker (1973) argues in Denial of Death that the fundamental human impulse is to "negate" death through heroism. "The most that any of us can seem to do is to fashion something-an object or ourselves-and drop it into the confusion, make an offering of it, so to speak, to the life force." Becker's book may have been such an offering, motivated by his own impending death. He died in 1975 at the age of 49.

5 How did Fromm understand death? Erich Fromm (1954) argued that awareness of death is part of our unique human gift: self-consciousness. We recognize that we live, we recognize that we will die. The only way to overcome the feeling of being a tiny, insignificant atom in the universe is to establish contact with something outside the self through such means as creative activity and love. Both Becker and Fromm, suggest that awareness of mortality motivates our finest human impulses—heroism, creativity, and love.

6 How did Maslow react to a brush with death? Abraham Maslow faced death when he suffered a sudden heart attack. He wrote: “The confrontation with death—and the reprieve from it—makes everything look so precious, so sacred, so beautiful, that I feel more strongly than ever the impulse to love it, to embrace it, and to let myself be overwhelmed by it....I wonder if we could love passionately, if ecstasy would be possible at all, if we knew we'd never die. (In Arkoff, 1975)”

7 How common is suicide? Suicide is a leading cause of death among young people. There are over 30,000 suicides per year in the United States and many more failed attempts. Scientists from many disciplines have worked together to try to understand suicide. Some of their findings confirm previous suspicions and stereotypes, others do not. Among the major findings are these:

8 What have researchers found out about suicide? 1.Suicide is typically not an isolated event in the life of an otherwise normal person. For example, a study of 67 teen suicides found that 40% of the victims suffered from "major depression" while at least a third were addicted to alcohol or other drugs. 2. Family problems are undoubtedly a major cause of unhappiness for some people, but people who commit suicide are just as likely to come from a warm and stable family as an abusive or unstable family. Suicide appears to result from individual psychological factors more than family problems. 3. The best predictor of suicide is a history of previous suicide attempts. 4. Suicide has a moderate tendency to run in families. "A person from a family of someone who attempts suicide has a higher risk of suicidality than someone from a family with no suicide attempts." (Holden, 1992)

9 What are some ethnic differences in the statistics about suicide? Blacks are 60% less likely to commit suicide than whites. In whites, the probability of suicide (after teenage years) goes up with age. Researchers have found that people who attempt suicide are often low in the brain transmitter serotonin. Increases serotonin levels in the brain decrease suicide.

10 The Work of Kubler-Ross Before the 1970s, psychologists treated death as taboo. One of the most important influences on changing attitudes was the work of a thanatologist (expert in studying death) named Elizabeth Kubler-Ross. Her book On Death and Dying (1969) was a landmark publication, signaling a new era of open discussion on the topic. Kubler-Ross got the idea for her book after working with terminally ill patients for two and a half years. The few who can do this will also discover that it can be a mutually gratifying experience; they will learn much about the functioning of the human mind, the unique human aspects of our existence, and will emerge from the experience enriched and perhaps with fewer anxieties about their own finality. (Kubler-Ross, 1969) Kubler-Ross identified five stages in the attitudes of a terminally ill patient. These were conceived as interchangeable phases, not necessarily stages in the sense of a fixed sequential ordering of development. In other words, she did not emphasize the exact ordering of these reactions, just the fact that different, identifiable reactions occurred.

11 What stages did Kubler-Ross identify? Denial Anger Bargaining Depression Acceptance Don’t Ask But Don’t Assume

12 Denial and Isolation The reaction of many people, told they have a terminal illness, is "No, not me! It can't be true! This is a natural defense against the shock of impending death, but usually it is only temporary. "Among our two hundred terminally ill patients, I have encountered only three who attempted to deny [death] to the very last," wrote Kubler- Ross. The rest moved on to other attitudes.

13 Anger A distinct stage for many terminally-ill patients was a sense of anger and injustice: "Why me?" This anger emerged at irregular times and was sometimes directed against people (or things)who had nothing to do with the basic situation. Often this was a difficult stage for relatives and doctors as well as the patient.

14 Bargaining Many patients felt they could strike some kind of bargain to postpone death. A. Good behavior. Patients stopped smoking, they volunteered to undergo painful therapies, and they devoted themselves to church activities. Kubler-Ross suggested these patients were operating on the premise that good behavior would be rewarded. If there were justice in the world, death would be postponed or eliminated by sufficient good behavior. B.Deadlines, such as a relative's wedding. The patient seemed to be saying, "God, if you let me live to see this wedding, then you can take me." Kubler-Ross noted that the patients never kept these promises, however; once the deadline was past, they would set up another deadline or special event to live for, and they would try to prolong the process.

15 Depression "When the terminally ill patient can no longer deny his illness, when he is forced to undergo more surgery or hospitalization, when he begins to have more symptoms or becomes weaker and thinner, he cannot smile it off anymore.“ Sometimes patients sink into depression after they get beyond denial, anger, and bargaining. Accepting the inevitability of death, they feel hopeless. The sense of impending loss of life becomes overwhelming. Medical expenses mount and patients may lose their life savings, be forced to sell a house which they built for their old age, or in other ways give up the hopes and dreams which gave life meaning.

16 Acceptance The final stage of dying is acceptance. It is not a time of joy or happiness-more like "quiet expectation“.

17 What is the common reaction to sudden and unexpected death of a loved one? When a loved one suddenly and unexpectedly dies, there is no time to raise defenses. A common reaction is denial: "It can't be!"

18 What are some criticisms of Kubler- Ross's work? Critics of Kubler-Ross say her scheme could lead to unreasonable pressures on a dying patient. Physician may expect a certain sequence of events  do not conform to the Kubler-Ross sequence may be seen as difficult or uncooperative. Lofland (1979) criticized the "happy death movement," which (she said) might prevent dying people from expressing their true feelings.

19 What is the "conventional wisdom" about mourning? After the initial shock, a psychological healing process is set in motion. But it takes time. The conventional wisdom is that bereavement (grief over death) lasts about two years after death of a spouse or loved one. One year is needed to absorb the reality of the person's death, another year to get back into normal social activities.

20 Stages in the Mourning Process The classic work on stages of grief came from Erich Lindemann,, titled "Symptomology and Management of Acute Grief”1944

21 What was Lindemann's classic proposal? 1. After an unexpected death, there is initial shock that lasts 10-14 days. 2. After the initial shock comes a period of intense sadness, and the grieving person may withdraw from social contact. 3. Next comes anger, as the grieving person seems to "protest" the unexpected death. 4. Finally, within a year or so, the grief is resolved and the person returns to normal. Criticisms of this scheme are much the same as criticisms of other stage theories. 1.Not everybody reacts the same way; actual data show wide variations in the time course and emotional phases of grief. 2. 2.If doctors and counselors expect a predictable series of stages, they may become impatient or presumptuous in their relations with grieving people.

22 What are criticisms of Lindemann's scheme? One expert on mourning, Dr. Mardi Horowitz of the University of California Medical School at San Francisco, said mourning is often incomplete, as if the surviving person is "frozen" at some point in the normal mourning process and cannot get it to pass. Horowitz believed the following stages represent a normal mourning process:

23 What is Horowitz's theory of grieving stages? 1. Immediately after the death, survivors may experience a wish to "do something" for the sake of the dead person, which Horowitz interprets as a sign the mourner has not begun to grasp the loss. An elaborate funeral, or even a simple service held "the way he would have wanted it" often satisfies this need. 2. Next, mourners may turn away from all reminders of death. 3. The mourner may feel numb in all emotions. 4. After regaining their emotional equilibrium, mourners typically engage in a review of their life with the deceased. To those without close ties to the deceased, this phase may occur immediately, and they may be full of memories of the deceased while at the funeral. "For those most upset by the death, though, it is usually weeks or months later that the vivid memories begin to flow." At that point, sadness or intrusive memories may make it hard to concentrate on anything else. Horowitz found that such emotional floods tend to alternate with periods of putting such feelings out of the mind, "so the mourning proceeds in manageable doses.“ 5. Feelings of intense grief fade with time. Yet, paradoxically, the survivor may experience a persistent longing for the deceased person at the same time life seems to get back to normal. Horowitz interprets this as a last attempt at denial. "This yearning gradually yields to an emotional acceptance of death." (Goleman, 1988)

24 What are Normal Reactions to Death? Not everybody reacts to the death of a loved one with spectacular emotional reactions such as depression or denial. Over half the widows and widowers studied by researcher Camille Wortman of The University of Michigan adjusted to the death of a spouse without exaggerated grief or despair. They grieved, but they were not obsessive in their grief; they went on with normal life activities. They did not show denial (pretending the spouse was still alive), and they did not show signs of depression.

25 What did Wortman find out when she interviewed widows and widowers? Belief systems may play a role in adjustment. A 1986 study of Mormons, who view marriage as eternal and continuing after death, found only one in five experienced severe depression in the months after a spouse died. Sudden loss of a child or a spouse, for example, in a car crash or highway accident, seems to produce a more prolonged and disturbing grief. Wortman found parents and spouses of auto accident victims had "painful thoughts and felt distressed" even four to seven years after the accident (Goleman, 1989).

26 What are typical experiences of parents to a miscarriage or the death of a newborn? Parents of babies who die at birth often experience profound grief reactions. Even parents who lose a child through a miscarriage (a natural abortion occurring before pregnancy is complete) may experience a full spectrum of grief reactions. They also may encounter lack of understanding about this grief from relatives and acquaintances, or insensitive comments such as "You can always have another." Such parents may be helped by peer counseling, which is simply meeting with a of people who have had similar experiences. One such group is A.M.E.N.D. (Aiding a Mother Experiencing Neonatal Death). Nobody can empathize with a grief-stricken parent as well as a person who has been through the same experience.

27 Death-Reconciliation Dreams The death-reconciliation dream is a type of dream, apparently occurring in all cultures, in which a dead person puts in an appearance. The departed one may "explain" the death or indicate the death was "OK" or "meant to occur" or "had to be." The dead person may say, "I'm up in heaven; don't worry," or the dreamer may use the opportunity to say a few last words, never spoken in real life. In some cultures, the appearance of a dead person is a special omen of good or bad events. Paul McCartney, interviewed in Musician (October, 1986) said the song "Let it be" was partly about a death-reconciliation dream. Musician: That's your mother invoked in "Let it be," isn't it? McCartney: I had a dream one night about my mother. She died when I was fourteen so I hadn't really heard from her in quite some while, and it was very good. It gave me some strength. In my darkest hour, Mother Mary comes to me. I get dreams with John in, and my Dad. It's very nice because you meet them again. It's wondrous, it's like magic. Of course, you're not meeting them. You're meeting yourself, or whatever...

28 American Way of Death Once upon a time, most deaths from illness took place at home. When a person was seriously ill, there was little to do but keep them comfortable and wait to see if they got better, and that could be done at home. Nowadays, expensive machines can keep dying people alive for months. Such machines are usually found only in hospitals, so nowadays 65% of deaths take place in hospitals rather than homes.

29 What are some problems associated with hospital deaths? Sometimes extraordinary measures such as special breathing machines can only postpone the inevitable. Quality of life for a person who only has a few weeks of life left  not at home but in hospital Cost  not unusual for an old person's life savings to be consumed in the last weeks of life.  28% of the Medicare budget goes toward maintaining people in the last year of life  typical hospital bills for terminally ill patients are between $20,000 and $75,000.

30 Hospice vs. Hospice Care Terminally ill patients who elect not to remain in a hospital setting may decide to spend their last days in hospice care. There is a difference between "a hospice" (a place where terminally ill patients can stay and receive nursing care) and "hospice care" (in which the patient stays at home and receives visits from nurses and other hospice workers).

31 What is the difference between "a hospice" and "hospice care"? Generally speaking, a patient is admitted to the hospice care category when a doctor believes the person has less than six months to live and no hope of recovery. In hospice care, doctors and nurses no longer attempt to fight the disease; all their emphasis is upon making the patient comfortable. Dosages of painkillers are raised as high as necessary to eliminate pain, and special equipment is provided to make breathing and other basic functions comfortable.

32 What often happens during hospice care? One might expect the atmosphere around a person under hospice care to be sad and depressed, but often the opposite is the case. Dying patients are often ready to die and wish only to spend their last days with loved ones, perhaps reviewing their life experiences and sharing valued memories. Often the most difficult task facing hospice workers is convincing family members to stop pretending the dying person is going to recover. People under hospice care often appreciate honesty and good company more than anything else.


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